This report from the American Academy of Pediatrics discusses appropriate prescribing practices for fluoroquinolones and reiterates that use of fluoroquinolones in children should continue to be limited to treatment of infections for which no safe and effective alternative exists.

The report considers the following topics:

• Safety: animal models, human studies
• Resistance
• Use of fluoroquinolones for paediatric infections
o conjunctivitis
o external otitis, tympanostomy
o tube–associated otorrhoea
o acute otitis media, sinusitis, and lower respiratory tract infections
o acute bacterial otitis media
o pneumonia
o gastrointestinal infections
o urinary tract infection
o mycobacterial infections
o other uses

In terms of safety, it was noted that “no compelling published evidence to date supports the occurrence of sustained injury to developing bones or joints in children treated with available fluoroquinolone agents; however, FDA analysis of ciprofloxacin safety data, as well as posttreatment and 12- month follow-up safety data for levofloxacin, suggest the possibility of increased musculoskeletal adverse effects in children who receive fluoroquinolones compared with agents of other classes.”